Healthcare Provider Details

I. General information

NPI: 1710534706
Provider Name (Legal Business Name): HANNA GEBREAB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9472 JESSICA DR
WINDSOR CA
95492-8867
US

IV. Provider business mailing address

2518 PAWNEE ST
SANTA ROSA CA
95403-3313
US

V. Phone/Fax

Practice location:
  • Phone: 707-836-8853
  • Fax:
Mailing address:
  • Phone: 707-480-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: